During this 5-year career development award Dr. Shiboski intends to integrate a study of oral disease in renal transplant recipients (RTRs) with a training plan that would expand her background in Oral Medicine and Epidemiology. The objectives of the proposed 5-year prospective cohort study are to 1) investigate the long-term side effects of corticosteroids and new generation immunosuppressants on the incidence of oral soft tissue disease and on changes in mandibular bone structure; and 2) determine if change in the fractal dimension of mandibular bone predicts change in bone mineral density of various skeletal sites, and may be used as a diagnostic tool to detect osteoporosis in this high risk population. RTRs (N = 360) will be recruited from the UCSF kidney post-transplant clinic, and followed at 1-year intervals. Measurements will include an oral soft tissue examination, evaluation of periodontal parameters, vertical bitewing radiographs, and an interview. In addition, fractal analysis will be conducted on dental radiographs and explored in relation to bone mineral density measured on two skeletal sites on a sub-sample of participants by Dr. Majumdar, an Associate Professor in Radiology. The training aspect of the award will be under the guidance of two mentors. Dr. John Greenspan will assist the candidate in learning aspects of molecular immunopathology and immunohistochemistry that are relevant to her research area. Dr. Ira Tager will advise the candidate about methodologic difficulties inherent in a longitudinal study of immunosuppressed subjects with complex medical histories. The candidate earned a PhD in Epidemiology and received post- graduate training in Oral Medicine as part of an individual Dentist Scientist Award. The proposed career development award would allow Dr. Shiboski to apply and expand her skills as a clinical oral epidemiologist to the study of oral disease in a chronically immunosuppressed population with various underlying systemic disorders (e.g., hyperparathyroidism; diabetes). The candidate intends to devote 80 percent effort to the proposed project.